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MALAYSIA’S ageing population is receiving considerable attention in the media and in government circles these recent months.

There is a profound social shift taking place which requires an equally profound shift in society’s mind set about ageing. Humans have strived for centuries to live longer; to cheat death. But the social change driven by our longer lives brings challenges, and for some, economic opportunities in the healthcare services industry.

Currently in Malaysia, the aged care needed by older people is delivered by government welfare homes (public sector), private nursing homes and care centres (for-profit) and voluntary aged care centres (non-profit, charitable) organisations and by families at home (with informal care). Within this diverse mix of services delivered by different agencies, each option has different funding bases.

Shortage of aged care services

The Malaysian aged care industry lacks enforcement, clarity and transparency in governance and framework. When help is needed, we as consumers, encounter frustrations and disappointments. In terms of the nursing homes with quality age care services and skilled staff, there is increasing demand but a lack of supply. Such a situation warrants immediate attention from the Government to ensure the evolution of a viable aged care system as we progress towards a high-income level society.

In recognition of the growing need for aged care, the Government has created Healthcare National Key Economic Area (NKEA) entry point projects for senior living within the Economic Transformation Programme (ETP). In the Healthcare NKEA handbook, it clearly states: “This growing segment of consumers is likely to create a need for outpatient care including seniors living facilities. “Seniors living care resides in the middle of the outpatient care continuum between post-operative check-ins on one end and acute care nursing homes on the other. The long-term goal is to create a number of centres offering assistance to people who need help with the activities of daily living, but wish to live as independently as possible, for as long as possible”.

Payment options for aged care

We know that moving into aged care facilities can be a stressful time for all involved. Working through the financial uncertainty can be just as overwhelming. A range of factors need to be considered in relation to aged care homes and understanding how these factors impact each other can make the process all the more demanding.

The key factors leading to enjoyable and sustainable aged care services vary quite noticeably on a case-to-case basis. It is unique to the person and difficult to predict. Similarly, the mechanisms used to pay for the services will differ markedly, including, amongst others, payments from personal savings, insurances and financial assistance from family.

The level of care a person needs is affected by their changing health and physical condition. And the duration of the care needed, and thus the cost, is never predictable.

Higher level of care needs will cost more depending on medication and clinical services required. Often, there are major drawbacks in monitoring and payment of these services when it is shouldered by the aged care users who are already frail or maybe even cognitively impaired.

If family members might not be around to help, the individual elderly person will have little bargaining power with the service providers for quality and affordable services. There is also a risk of exploitation by service providers.

Even if there are operators providing aged care services and financial advisors are available to provide financial planning advice, the self-directed payment system does not offer a guarantee of sustainability of care provision until end of life for the individuals.

There is simply no sustainable integrated mechanism available for us to ensure sufficient funding for elderly Malaysians who need care.

Lack of aged care financing

Other than personal savings for retirement, there are limited financial protection programmes other than Employees Provident Fund (EPF) for payment of hospital expenses (from Account 2), employment injury for private sector workers under the Social Security Organisation or Socso, the Armed Forces Fund Board, Pension Scheme for government staff and social welfare programmes under the National Welfare Department.

While the social protection programmes are limited to the formal sector, the self-employed and unemployed including housewives are often excluded from these programmes.

As a progressive nation, it is necessary for the Government to prioritise the need to frame an aged care financing programme for the aged care needs of elderly Malaysians from different demographic and socio-economic levels. The new Minimum Retirement Age of 60 for private sector and the implementation of Private Retirement Scheme by the Securities Commission indicate the need to boost the ability of Malaysians to make and save more money for retirement and aged care needs. Will these initiatives put future Malaysians in a position to pay for their aged care needs?

EPF is often thought of as the central contributor to income security for the elderly. The current arrangement has been found to be inadequate to meet retirement needs (not to mention aged care needs) because of increasing cost of living and medical expenses.

Families have become the central welfare provider both in monetary terms as well as in the provision of social support to the elderly. It is not surprising that the most common source of support for the elderly is money from adult children. Although inter-generational relationships may presently be in flux, both co-residence and reliance on family assistance are outcomes for most elderly Malaysians.

Infrastructure

Time is the essence for us to determine if Malaysia will achieve the Healthcare ETP objectives. Will elderly Malaysians enjoy sustainable, affordable and quality aged care services someday?

To lessen the financial burden to supporting families, government intervention is needed to tackle aged care issues. There has to be a priority to design an integrated sustainable aged care infrastructure as a means of preventing elderly Malaysians from falling below the poverty line. This infrastructure should have the following objectives:

● Improve the equity and sustainability of aged care financing instruments and products.

● Improve returns on investment in residential care centres and homes to encourage capital investment and quality care instead of passing the costs to consumers.

● Introduce legislation to control possible exploitation of aged consumers.

● Support better links between aged care services and wider health system in urban and rural areas.

The immediate goal is to create flexible and seamless aged care services that provide Malaysians with more choice, more control and easier access to a full range of services, where they want it, when they need it and at an affordable cost. At the same time, implement an integrated aged care financing system that takes into account the needs of consumers, the business imperatives of providers and the Government’s commitment to provide affordable and sustainable aged care. Should this not be a top agenda item for the new term of government? – By CAROL YIP

The Aged Healthcare Act aimed at developing and improving regulations for the aged care industry would be tabled in Parliament by the end of next year, Health Minister Datuk Seri Dr S. Subramaniam (pic) said today.

He said the ministry was currently, drafting the Act.

“The Act will ensure minimum standard for all healthcare support and services for the elderly in the country,” he said at a press conference in Putrajaya today.

Citing an example, Dr Subramaniam said nursing homes for the elderly fell under the Private Healthcare Facilities and Services Act and was regulated by the health ministry and welfare department.
However, under the proposed new Act, he said the nursing home which did not provide health, medical or hospice care for the elderly would be registered under the welfare department.

“Anything with medical and nursing care, the proposed Act will regulate and put a standard on that,” he said.

Serdang Hospital ceiling collapse

Meanwhile, Dr Subramaniam said the ministry would take stern action, including filing a law suit against the contractor of the Serdang Hospital, following incidents of collapsed ceiling slabs.

“The ministry does not blackout these issues. The contractor is the one who is responsible for the building. We will take the necessary action… whether they are liable or not, depends on the report we received from the public works department,” he said.

He said the ministry was keeping a close watch on the Serdang Hospital whose ceiling was inspected on a daily basis to detect “danger elements” and rectify them immediately.

He said the ministry had allocated RM30 million for repair and maintenance work at the hospital.

“We have identified two major issues, namely support for the ceiling and the condensation issue due to the air-conditioning system. We have begun work to strengthen some of the areas and are trying to prevent condensation,” added the minister.

Since the hospital was officially opened in December 2005, there were several incidents of collapsed ceiling slabs at its premises.

On September 20, this year, portions of the ceiling at the hospital’s maternity ward gave way and on November 14, parts of the ceiling at the paediatric intensive care unit collapsed.

On January 30, 2011, a ceiling collapsed at the hospital’s main lobby while on August 13, last year, three nurses and a female medical officer were injured when 15 ceiling pieces collapsed at the hospital’s emergency department. – Bernama